Claim

Trial Use 2 Financial

A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.

Endpoints

alphahttps://api.dev.ovok.com/fhir/R4/Claim

Interaction	Method	Path
Read	GET	/fhir/R4/Claim/[id]
Vread	GET	/fhir/R4/Claim/[id]/_history/[vid]
Update	PUT	/fhir/R4/Claim/[id]
Patch	PATCH	/fhir/R4/Claim/[id]
Delete	DELETE	/fhir/R4/Claim/[id]
Create	POST	/fhir/R4/Claim
Search	GET	/fhir/R4/Claim
History	GET	/fhir/R4/Claim/[id]/_history

Top-level elements

Element	Type(s)	Cardinality	Description
identifier	Identifier	0..*	Business Identifier for claim
status	code	1..1	active | cancelled | draft | entered-in-error modifier
type	CodeableConcept	1..1	Category or discipline
subType	CodeableConcept	0..1	More granular claim type
use	code	1..1	claim | preauthorization | predetermination
patient	Reference	1..1	The recipient of the products and services
billablePeriod	Period	0..1	Relevant time frame for the claim
created	dateTime	1..1	Resource creation date
enterer	Reference	0..1	Author of the claim
insurer	Reference	0..1	Target
provider	Reference	1..1	Party responsible for the claim
priority	CodeableConcept	1..1	Desired processing ugency
fundsReserve	CodeableConcept	0..1	For whom to reserve funds
related	BackboneElement	0..*	Prior or corollary claims
prescription	Reference	0..1	Prescription authorizing services and products
originalPrescription	Reference	0..1	Original prescription if superseded by fulfiller
payee	BackboneElement	0..1	Recipient of benefits payable
referral	Reference	0..1	Treatment referral
facility	Reference	0..1	Servicing facility
careTeam	BackboneElement	0..*	Members of the care team
supportingInfo	BackboneElement	0..*	Supporting information
diagnosis	BackboneElement	0..*	Pertinent diagnosis information
procedure	BackboneElement	0..*	Clinical procedures performed
insurance	BackboneElement	1..*	Patient insurance information
accident	BackboneElement	0..1	Details of the event
item	BackboneElement	0..*	Product or service provided
total	Money	0..1	Total claim cost

Resource-specific search parameters

Parameter	Type	Description
_compartment	string
_count	string	https://www.hl7.org/fhir/search.html#_count
_elements	string	https://www.hl7.org/fhir/search.html#_elements
_id	string
_lastUpdated	string
_profile	string
_security	string
_sort	string	https://www.hl7.org/fhir/search.html#_sort
_source	string
_summary	string	https://www.hl7.org/fhir/search.html#_summary
_tag	string
_total	string	https://www.hl7.org/fhir/search.html#_total
care-team	string	http://hl7.org/fhir/SearchParameter/Claim-care-team
created	string	http://hl7.org/fhir/SearchParameter/Claim-created
detail-udi	string	http://hl7.org/fhir/SearchParameter/Claim-detail-udi
encounter	string	http://hl7.org/fhir/SearchParameter/Claim-encounter
enterer	string	http://hl7.org/fhir/SearchParameter/Claim-enterer
facility	string	http://hl7.org/fhir/SearchParameter/Claim-facility
identifier	string	http://hl7.org/fhir/SearchParameter/Claim-identifier
insurer	string	http://hl7.org/fhir/SearchParameter/Claim-insurer
item-udi	string	http://hl7.org/fhir/SearchParameter/Claim-item-udi
patient	string	http://hl7.org/fhir/SearchParameter/Claim-patient
payee	string	http://hl7.org/fhir/SearchParameter/Claim-payee
priority	string	http://hl7.org/fhir/SearchParameter/Claim-priority
procedure-udi	string	http://hl7.org/fhir/SearchParameter/Claim-procedure-udi
provider	string	http://hl7.org/fhir/SearchParameter/Claim-provider
status	string	http://hl7.org/fhir/SearchParameter/Claim-status
subdetail-udi	string	http://hl7.org/fhir/SearchParameter/Claim-subdetail-udi
use	string	http://hl7.org/fhir/SearchParameter/Claim-use

Reference

• Official FHIR R4 spec: Claim
• Maturity: Trial Use 2 (FMM 2).